GLHA Return to Play 2.0 - 2021-2022 Season - West London Minor Hockey
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GLHA Return to Play 2.0 2021-2022 Season The GLHA would like to thank Hockey Canada, the Ontario Hockey Federation, the Greater Toronto Hockey League, Hockey Nova Scotia, and the Middlesex-London Health Unit for permitting GLHA to use content from their Return-to-Play guidelines and COVID-19 management recommendations.
Disclaimer The information provided in this document was current at the time of publishing and was written in compliance with guidance from Hockey Canada, the Ontario Hockey Federation (OHF), the Minor Ontario Hockey Association (Alliance), the Ontario Recreation Facilities Association, and the Middlesex- London Health Unit, along with COVID-19 recommendations published by the Government of Ontario. The Greater London Hockey Assocation (GLHA) recognizes that as has been the case throughout the COVID-19 pandemic, recommendations and requirements may change at any time depending on local, provincial, and national circumstances. If ever anything in this document conflicts (i.e., is less restrictive) than public health requirements, including local and provincial regulations, the more restrictive of the two will stand. The information in this document is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content is provided for general informational purposes only. The GLHA assumes no responsibility for the accuracy or completeness of this document. In addition, participants seeking advice about the safe return to play, should seek advice from a medical professional and/or public health officials. GLHA is aware that return to hockey is not without risks, including the potential for an exposure to COVID-19. For this reason, GLHA follows all recommendations of its local public health unit yet even still, cannot guarantee no risk of exposure and transmission for those participating in on or off-ice activites. While GLHA is making all reasonable efforts to minimize the risk of exposure and potential transmission, individuals involved in sanctioned events do so at their own risk. Should a parent and/or player ignore or circumvent the protocols outlined in this document or any updated GLHA COVID-19 protocols, the player and/or parent will be asked to leave the rink immediately. Violations may be subject to disciplinary action. September 13, 2021 2
Table of Contents Disclaimer ............................................................................................................................. 2 Definitions and Acronyms ...................................................................................................... 4 Section 1: Administration ...................................................................................................... 4 Section 2: COVID-19 Roles and Responsibilities...................................................................... 5 Bench Staff.....................................................................................................................................5 Coaching Staff ................................................................................................................................5 Trainers & Equipment Staff.............................................................................................................5 On-Ice Officials ...............................................................................................................................5 Section 3: Facilities ............................................................................................................... 6 Section 4: General Guidance ................................................................................................. 7 Section 5: Tournaments ........................................................................................................ 8 Section 6: Vaccination........................................................................................................... 8 Section 7: Spectators .......................................................................................................... 10 Section 8: Protocols ............................................................................................................ 10 Arrival at the Rink ........................................................................................................................ 10 Screening ..................................................................................................................................... 11 Attire and Equipment ................................................................................................................... 11 Dressing Rooms............................................................................................................................ 11 Leaving the Rink ........................................................................................................................... 12 Section 9: Illness ................................................................................................................. 12 If a Participant Reports Illness BEFORE Arriving to the Arena: ........................................................ 12 If Someone Experiences Illness DURING an Event at the Arena: ..................................................... 13 If a Participant Tests Positive for COVID-19 ................................................................................... 13 Appendix A: OHF Tracking Form .......................................................................................... 14 Appendix B: Medical Exemption to Decline the COVID-19 Vaccine ....................................... 15 September 13, 2021 3
Definitions and Acronyms “Fully Vaccinated” refers to an individual that has received a completed series of a COVID-19 vaccine plus fourteen (14) days. “GLHA” refers to the Greater London Hockey Association which is made up of the London Bandits, North London Nationals, Oakridge Aeros, and West London Hawks hockey associations. “Member” refers to any participant, coach, volunteer, etc. “MLHU” refers to the Middlesex-London Health Unit “Participant” refers to any person registered to the GLHA including the parent(s) and/or legal guardian(s) of any minor aged participant that engages or volunteers in any GLHA or league sanctioned activity (includes on ice/off ice helpers, volunteers, etc.) “Sanctioned Event” means any game, on-ice practice, off-ice training, or any other activity involving players and other team members that is approved by a GLHA hockey association, the GLHA, the Ontario Hockey Federation (or any of its members), or Hockey Canada (or any of its members). “Team” means any group that includes players, coaches, on-ice instructors, volunteers, organization administrators, etc., who gather for a sanctioned hockey activity on and/or off the ice. “Vaccine Eligible” means any individual that meets the criteria for vaccination as determined by the local public health unit Section 1: Administration 1. The GLHA advises all associations to ensure they are compliant with the following: a. Hockey Canada’s Return to Hockey guidance b. Ontario Hockey Federation Return to Hockey guidance c. Alliance Hockey guidance 2. All on ice instructors must be certified by the Alliance. 3. The GLHA advises that all associations are to establish a COVID-19 Manager. 4. The roles of the COVID-19 Manager includes: a. Keeping each association informed of the most current COVID-19 health directives pertaining to amateur sports leagues b. Assisting the association with implementation of COVID-19 health directives c. Facilitating contact tracing in the event of a COVID-19 exposure d. Communicating with any relevant public health authority, the involved participant(s)/parent(s)/volunteer(s), the association, league, and facility, as required e. Ensuring teams are following the association’s COVID-19 guidelines and any other pertinent local, provincial, and national COVID-19 requirements September 13, 2021 4
At the time of writing this document, the COVID-19 Managers are: London Bandits Tina Barnes Tlauzon22@hotmail.com West London Kendra Ramer Kendra.ramer@mlhu.on.ca Mike Rivard Mike_rivard33@hotmail.com Oakridge Aeros Jen Schimmer jschimmer@rogers.com North London Nationals Emily Hahn-Trnka Emily.hahn.trnka@gmail.com London Junior Mustangs Sionainn Pryce-Hynes sprycehynes@middlesexcl.on.ca GLHA Christine Moussa Christine.moussa@cicprofessionals.ca 5. All members must be registered with our association and required payment complete before participating in any sanctioned event. 6. GLHA encourages all hockey-related activities (including parent meetings) be conducted electronically. Any required, in-person meetings must be conducted in compliance with the Ontario Government’s requirements including maximum group numbers, physical distancing requirements, masking, etc. Where physical distancing is difficult to maintain, meetings should be held outdoors. 7. No community or sponsor appearances are permitted at this time. 8. Players will be allowed to move from House League to MD and MD to Mustangs in order to fill roster vacancies. There is no required waiting period for this. Section 2: COVID-19 Roles and Responsibilities Bench Staff • Work with facility staff to ensure the bench areas are cleaned and disinfected after each session • Ensure a garbage can or plastic bag is available for all waste, and removal of the bag • Maintain physical distancing with participants as much as possible • Enforce physical distancing and masking protocols in the bench area Coaching Staff • Maintain physical distancing with participants as much as possible • Enforce physical distancing and masking protocols in the bench area Trainers & Equipment Staff • Non-latex gloves must be worn when on the bench for each practice and game • Gloves must be worn when handling equipment • Cloth masks should be worn if treating players, dealing with players’ equipment, or if physical distancing is not possible • Gloves must be changed when required and hands must be washed frequently On-Ice Officials • On-Ice Officials are not governed by the GLHA September 13, 2021 5
• On-Ice Officials will be responsible for abiding by their governing body’s COVID-19 protocols as well as any applicable COVID-19 requirements of the facility, the City of London, and the Middlesex-London Health Unit Section 3: Facilities 1. The following rinks may be used in the GLHA and under the City of London. All participating individuals will need to follow any facility-specific COVID-19 guidelines. Western Fair 865 Florence St 4 pads London, ON 519-439-7203 Bostwick 501 Southdale Road West 2 pads London, ON 519-661-5575 Medway Arena 119 Sherwood Forest Square 1 pad London, ON 519-661-4421 Kinsmen Arena 20 Granville Street 2 pads London, ON 519-661-5777 Argyle Arena 1948 Wavell Street 2 pads London, ON 519-661-4419 Stronach Arena 1221 Sandford Street 2 pads London, ON 519-661-4426 Earl Nichols Arena 799 Homeview Road 3 pads London, ON 519-661-4422 Carling Arena 675 Grosvenor St 2 pads London, ON 519-661-5774 Oakridge Arena 825 Valetta Street 1 pad London, ON 519-661-4424 Silverwood Arena 50 Sycamore Street 1 pad London, ON 519-661-4425 Farquharson Arena 411 Tecumseh Avenue East 2 pads London, ON 519-661-5575 2. Teams will be asked to check in with a City of London employee when they are entering a facility. Note that the front door may be locked after teams enter the facility for their designated ice time. September 13, 2021 6
3. Facilities will follow established cleaning protocols with a focus on high use areas and high touch points such as washrooms, dressing rooms, benches, doors, and handles. 4. City of London staff have the right to enforce the facility’s COVID-19 protocols, including the right to refuse entry if facility maximums are met and/or an individual does not comply with any of the COVID-19 protocols. Section 4: General Guidance 1. All participants, spectators, coaches, and volunteers are expected to observe measures that reduce the risk of transmission of COVID-19 and other respiratory illnesses including, but not limited to, hand hygiene, physical distancing, wearing of appropriate masks, respiratory etiquette, self-screening, isolation if ill or in contact with an ill-individual. 2. All participants, spectators, coaches, and volunteers are expected to follow any facility-specific COVID-19 protocols including screening requirements, following signage including observing designated sitting/spectating areas, respecting room maximums, including dressing rooms, etc. 3. Anyone entering an arena is encouraged to use alcohol based hand sanitizers when entering and exiting the facility, as well as at regular and frequent intervals while in the facility. All are encouraged to carry personal hand sanitizer to and from the rink. 4. All individuals entering the facility are expected to wear a mask, and must continue to wear a mask throughout the facility. Only participants and referees are permitted to remove their masks while on the ice. Coaches and participants on the bench are expected to wear a mask. 5. According to the Middlesex-London Health Unit, masks and face coverings can include a medical or non-medical mask or face coverings including a bandana, scarf cloth, or similar item that covers the nose, mouth, and chin without gapping. 6. Exemptions to mask wearing are possible and outlined by the City of London and/or Middlesex- London Health Unit. 7. Absolutely no sharing of food and drinks should occur. 8. No spitting or blowing noses without a tissue. Consequences, including removal from the arena, are possible. A team may wish to have tissues on hand for this purpose. Tissues must be immediately disposed of in a garbage can and the individual should perform hand hygiene after blowing his/her nose. 9. No handshakes will be allowed before or after the game. Coaches should verbally greet their participants. 10. Minimize entering and exiting the building, and rooms within the building, to decrease contact with high touch items like doors. If possible, use the elbow or other body part to open a door. 11. Information about COVID-19, including signs and symptoms and what to do if you think you have COVID-19, can be found on the Middlesex-London Health Unit’s website. September 13, 2021 7
Section 5: Tournaments 1. GLHA recognizes that tournaments may occur during the 2021/2022 season, provided additional restrictions are not put in place by local Public Health Units or the provincial government. 2. This Return to Play protocol is not intended to limit GLHA teams’ participation in sanctioned events in any jurisdiction outside of the GLHA that may have a different vaccination policy, provided all relevant Public Health Unit and provincial government COVID-19 protocols/regulations/recommendations are followed. 3. While participating in a tournament outside of the GLHA, GLHA expects that its players, coaches, volunteers, bench staff, parents/guardians and any other attendees affiliated with the team, will respect and follow all COVID-19 protocols required at hotels, arenas, restaurants, and other locations within the tournament’s community. Section 6: Vaccination 1. In keeping with the recommendation of the Middlesex-London Health Unit (MLHU), the GLHA has established a policy requiring all vaccine-eligible coaches, volunteers, bench staff, and participants to be fully vaccinated against COVID-19 as a condition of participating in any GLHA sanctioned activities. Individuals must be fully immunized (i.e. including the 14-day period after receiving the completed series) by October 31, 2021. 2. All third-party development personnel participating in GLHA sanctioned activities must comply with the league vaccine policies as well and public health, facility, and government vaccine guidelines. Member Associations are responsible for ensuring all required documentation has been submitted. 3. Anyone with a history of confirmed COVID-19 disease is not exempt from this policy. 4. For the purpose of this policy, at the time of writing, vaccine eligible means any individual who is 12 years or older OR is turning 12 in the current year. 5. A player that is not eligible by age/birth year in 2021, must complete their vaccination series within 60 days of becoming eligible (i.e. for a player turning 12 in 2022, the player must be fully vaccinated by March 1st, 2022. 6. At any time during the course of the season should a change to vaccine eligibility occur (e.g. vaccine approval for younger age groups), the same principles will apply (i.e. the player will be required to be fully vaccinated 60 days after becoming eligible). 7. This requirement does not apply to spectators however, the GLHA encourages anyone entering a facility for a hockey-related activity to consider vaccination. It should also be noted that a vaccination requirement for spectators may be imposed at any time by the owners/operators of any facility, local public health officials, other provincial or national bodies, or GLHA. 8. All COVID-19 vaccine products approved for use by Health Canada are considered an acceptable COVID-19 vaccination. 9. If a participant or parent/guardian would like to request that a non-Health Canada approved vaccine be considered, they must contact GLHA. September 13, 2021 8
10. Until such time as a provincial digital vaccine certificate is operational, eligible participants (or a parent/guardian) must present official documentation of a full vaccine series at least 24 hours prior to the participant’s first skate or first attendance at a GLHA sanctioned event in the case of a coach, volunteer, or bench staff. The receiver will validate that two doses of vaccine have been administrated to the participant prior to October 17, 2021. 11. Acceptable documentation of vaccination includes: a. A digital or physical Dose Administation Receipt b. Provincial Government issued verification passport 12. GLHA reserves the right to request confirmation of vaccination again, once the provincial digital vaccine certificate program is operational. 13. Participants requiring a record of their vaccination can obtain it by visiting this link. Note: you will need date of birth, postal code, and health card information in order to access a vaccination receipt online. You can only access a vaccination receipt through the provincial COVID-19 vaccination portal if you have a green Ontario Health Card and presented the card at the time of vaccination. 14. Vaccination records will be reviewed and/or collected by each Association’s Risk Manager(s) and Registrar(s) for the purpose of uploading the documents to the Hockey Canada Registry system. Each individual’s information will be stored in his/her secure, Hockey Canada Profile and/or the new Spordle HCR 3.0. Whether collected verbally, in writing, or electronically, vaccination records will be kept confidential and only released beyond what is described above if required by law or requested by a local public health unit under legislative obligation (e.g. for the purposes outlined in the Health Protection and Promotion Act). 15. GLHA recognizes its duty to accommodate those who are unable to receive a vaccination due to a substantiated medical reason and/or for reasons protected under the Ontario Human Rights Code, to the point of undue hardship. Personal, philosophical, and/or ideological objections to the COVID-19 vaccine will not be accepted for granting an exemption from receiving the COVID- 19 vaccination. Individuals who are unvaccinated for COVID-19 (i.e. those who submit a completed exemption form or whose vaccine status information is incomplete) will be required to conduct COVID-19 rapid testing. Submit all forms to the following link. Please all 72 hours for the ALLIANCE to process your submission. a. Medical Exemption - A participant may submit a request for medical exemption for medical reasons to be reviewed by a representative of ALLIANCE Hockey. Permitted medical exemptions are listed on Appendix B. Submitted documentation will be reviewed by a representative of ALLIANCE Hockey and the individual or parent/guardian will be notified if the exemption request was accepted. b. Creed/Religious Exemption: An individual may submit a request for creed/religious exemption by completing the Request for Creed/Religious Accommodation regarding mandatory vaccination for participation in GLHA-sanctioned hockey activities form, if they are declining vaccination for themselves or their child due to a Human Rights Code protected ground. The submitted documentation will be reviewed by a representative of ALLIANCE Hockey and the individual or parent/guardian will be notified if the exemption request was accepted. September 13, 2021 9
16. Exemption requests will NOT be handled by individual hockey associations, they will be managed via ALLIANCE Hockey. All documents regarding COVID-19 accommodations for the affected person will only be collected, used, retained, or disclosed by ALLIANCE Hockey or any of its Member Assocations as may be necessary for legitimate operational purposes or as directed or requested by governmental authorities or as may be required by law. 17. Participants that have been granted an exemption with accommodation must show proof of a negative COVID-19 Rapid Antigen Screen at least 24 hours prior to each sanctioned GLHA event. Testing is at the expense of the participant and are available at Shoppers Drug Mart. A negative COVID-19 test will be considered invalid after the 72-hour period and a repeat test is required for continued participation in GLHA sanctioned events. 18. COVID-19 test results will be reviewed by each Association’s Director of Risk. The results will be stored in a locked filing storage system for the duration of the season. Testing results will be kept confidential and only released if required by law or requested by a local public health unit under legislative obligation (e.g. for the purposes outlined in the Health Protection and Promotion Act). 19. These requirements are effective as of the publishing of this protocol, with due regard for the availability of COVID-19 vaccines. 20. If at any time the local public health unit (e.g. MLHU) or the provincial government states that unvaccinated participants are no longer eligible to play in a large cohort, the participant may be displaced to a smaller cohort or may be considered ineligible to play. The participant may join their larger cohort at the time Public Health allows unvaccinated participants to play in a large cohort or the participant is fully vaccinated. Section 7: Spectators 1. The number of participants/coaches/volunteers and spectators allowed at a rink must comply with the current provincial stage of opening. Each rink will have a different capacity. Please check with your local rink. 2. At the time of the writing of this policy, each skater is permitted two spectators (e.g. Parent/Parent, Parent/Guardian, Parent/Sibling, Parent/Grandparent, Guardian/Grandparent, Grandparent/Sibling, Guardian/Sibling). This limit is subject to change, based on facility, city, and/or MLHU requirements. 3. When spectators are permitted, they must view the practice/game in designated viewing areas. Section 8: Protocols Arrival at the Rink 1. Carpooling should be discouraged. If carpooling cannot be avoided, it is strongly recommended that all passengers wear a face mask while in the vehicle. 2. Each facility will have its own protocols related to capacity limits, flow through the building, and use of dressing rooms, washrooms, etc. Participants, coaches, volunteers, and spectators are September 13, 2021 10
expected to abide by each facility’s protocols, in addition to the protocols set out in this document. 3. All participants, spectators, coaches, and volunteers must enter the rink through the designated doors. 4. Participants, spectators, coaches, and volunteers will be expected to arrive at the facility no earlier than 15 minutes before ice time, to allow individuals leaving the facility enough time to do so safely. Individuals arriving early to the facility will not be allowed in ahead of schedule. 5. Physical distancing of two metres will be maintained before, during, and after hockey-related activities, except where otherwise stated in Hockey Canada’s and/or the Ontario Hockey Federation’s COVID-19 guidelines. 6. There will be no team warm-ups permitted in the facilities. Activities that bring participants together should be avoided, as it can be difficult to maintain proper physical distancing. Screening 1. Anyone entering a rink must undergo COVID-19 screening and complete any necessary documentation (written or electronic). 2. Rink staff will greet each individual at the door. Anyone entering the rink must comply with the screening protocol. Failure to comply will result in the participant and/or parent/guarden being unable to enter the arena and participate in programming. 3. Both participant and parent/guardian must complete the screening process. 4. The most current screening form can be found here (add link to updated form here) 5. An OHF Tracking Form must be complete for each on-ice session. This Form is necessary to facilitate contact tracing in the event of a COVID-19 exposure. See form below. Attire and Equipment 1. Participants should have a personal, clearly labelled water bottle that is cleaned in between sessions. Participants should be encouraged to fill their water bottles at home. 2. The sharing of water bottles is prohibited. 3. As much as is possible, participants are to come to the rink dressed in hockey attire and equipment, provided it is safe to do so and weather permitting. 15 minutes is allotted for dressing room use prior to each skate, should a player require time to finish dressing. 4. Hockey equipment and participant’s clothing should be kept clean. Equipment should be maintained according to manufacturer’s guidelines. 5. Sharing of hockey equipment or warm up equipment/supplies is discouraged. When sharing may be required (e.g. goaltender equipment at the house league level), it must be sufficiently cleaned and disinfected between participants. 6. Towels should only be on the bench under the guidance of the Team Safety Rep/Trainer and for emergency use only. A towel should only be used once and then removed from the bench for laundering. 7. Participants are not to use the showers in any facilities at this time. September 13, 2021 11
Dressing Rooms 1. At this time use of dressing rooms is permitted. Gender identity change rooms and girls change rooms will be available. 2. Each facility will have its own protocols related to dressing room use and all participants, coaches, and volunteers are expected to follow them. 3. If dressing rooms are at capacity, chairs/benches will be available outside of the dressing rooms/in the lobbies. 4. Spectators are strongly encouraged to avoid the dressing rooms at all times, unless it is necessary to attend an injured or unwell participant. 5. Anyone in the dressing rooms must observe physical distancing and wear a mask. 6. Anyone using the dressing rooms must do so in a timely way, and must not remain in the dressing room any longer than is required to change. At this time of writing this document, a limit of 15 minutes is allowed at the beginning and end of the scheduled ice time. 7. Team staff should attempt to control the number of times participants enter and exit the dressing room, as this will decrease contact with the doors. Leaving the Rink 1. Participants must put on their mask immediately once off the ice and helmet removed. 2. Participants, spectators, coaches, and volunteers leaving the facility are expected to do so in a timely way, leaving via the designated exit and within 15 minutes of leaving the ice. Nobody is permitted to stay beyond their designated time. 3. Physical distancing of two metres will be maintained before, during, and after hockey-related activities, except where otherwise stated in Hockey Canada’s and/or the Ontario Hockey Federation’s COVID-19 guidelines. 4. All participants, spectators, coaches, and volunteers are expected to leave through the designated exit doors, generally found on each side of the rink. Section 9: Illness 1. Anyone experiencing signs and symptoms of COVID-19 should stay home. Current testing site information can be found on the Middlesex-London Health Unit (MLHU)’s website. The provincial government has created a COVID-19 self-assessment system online to help you determine what to do next. For players, you will use the COVID-19 school and child care screening process. If a Participant Reports Illness BEFORE Arriving to the Arena: 1. If a participant is experiencing signs and symptoms of COVID-19 and will not be participating in a hockey event, the participant and/or parent/guardian should notify the coach. 2. If the participant is tested and negative, he/she can return to the rink if all the following apply: a. He/she does not have a fever (without using medication) b. It has been at least 24 hours since symptoms have started to improve (or 48 hours if he/she has nausea/vomiting/diarrhea) September 13, 2021 12
c. If he/she was not in close physical contact with someone who currently has COVID-19 3. A player who has been tested and is negative and meets all the criteria in #2, must show evidence of the negative COVID-19 test to return to play. 4. If the player does not get tested, he/she must isolate for 10 days and cannot return to the rink prior to 10 days unless all of the following apply: a. A doctor diagnoses the player with another illness that resulted in the symptoms b. The player does not have a fever (without the use of medication) c. It has been at least 24 hours since symptoms started improving (or 48 hours if the player had nausea/vomiting/diarrhea). 5. For a player that tests positive, see below. If Someone Experiences Illness DURING an Event at the Arena: 6. If an individual is experiencing a medical emergency, contact 911. 7. If a participant begins to feel unwell while at the arena: a. Ask the participant to put on his/her mask, if he/she is not wearing one b. Assist the participant with immediately leaving the arena. The participant may require support from his/her parent/guardian or a coach/volunteer/trainer/Safety Rep 8. If a player exhibits signs and symptoms of COVID-19 while at the arena and a parent/guardian is not present, a coach/volunteer/trainer/Safety Rep can accompany the ill player to a well- ventilated area and facilitate contacting of a parent/guardian for pick up, if assistance is required 9. All coaches have a right to send a player home if he/she observes signs of an illness that were not disclosed appropriately upon entrance to the facility. The parent/guardian is expected to respectfully remove the participant from the arena and follow all necessary COVID-19 protocols. 10. If a player and/or parent/guardian/accompanying individual does not cooperate with this protocol, facility staff should complete an incident report based on facility protocol, prior to the coaching staff leaving the facility. If a Participant Tests Positive for COVID-19 1. If a participant or anyone in the participant’s home tests positive for COVID-19, must immediately be removed from the hockey environment. 2. The participant must report the result to public health unit and follow all guidance provided by the public health unit. 3. The public health unit is responsible for provided advice related to communication protocols and contact tracing. 4. Any participant with suspect or confirmed COVID-19 cannot return to the hockey environment until a public health authority has advised him/her to return. 5. A note from a medical provider or public health official may be required to return to play. 6. If any siblings/household contacts within the positive player’s home also play for a GLHA association, they are considered a close contact and must also be removed from play until they have been cleared by the local public health unit. September 13, 2021 13
7. If a coach and/or association is notified that a participant/coach/close contact has tested positive for COVID-19, the association will follow all advice given by the local public health unit. Appendix A: OHF Tracking Form All participants/coaches/volunteers are expected to complete Health Screening prior to each on-ice activity. The Health Screening may be completed verbally. By indicating YES in the chart below, you confirm that this Health Screening was passed. Session Location Ice Pad Date Time List all individuals in session. Include Phone Number Health Screening Pass coaches, instructors, and participants. (Yes or No) 01 02 03 04 05 06 07 08 09 10 11 12 13 September 13, 2021 14
14 Appendix B: Medical Exemption to Decline the COVID-19 Vaccine The following conditions are the only absolute medical exemptions from the COVID-19 vaccine: 1. Documented anaphylaxis to a previous dose of COVID vaccine or documented anaphylaxis to one of the vaccine components in authorized, available COVID-19 vaccines: Vaccine Product Potential allergen included in the vaccine or its container Pfizer-BioNTech COVID-19 vaccine Polyethylene glycol (PEG) Moderna COVID-19 vaccine PEG Tromethamine (trometamol or Tris) AstraZeneca COVID-19 vaccine Polysorbate 80 Ref: see NACI’s Recommendations on the use of COVID-19 vaccines, Table 4 for complete details These recommendations are in accordance with the guidance expressed by the National Advisory Committee on Immunizations (NACI) as of July 2, 2021 on non-medicinal ingredients of authorized, available COVID-19 vaccines that have been associated with allergic reactions in other products. 2. Individuals with a history of myocarditis and/or pericarditis should discuss the risks and benefits of receiving an mRNA vaccine or, alternately, the risks and benefits of receiving a viral vector vaccine (AstraZeneca) with their treating physician and/or primary care provider. September 13, 2021 15
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